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Owner Surrender Form
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Owner Surrender Form
OWNER SURRENDER INFORMATION
Date of Request
*
MM slash DD slash YYYY
Employee Initials
What kind of animal are you surrendering?
*
DOG
CAT
OTHER
Puppy?
Yes
No
Kitten?
Yes
No
Declawed?
Yes
No
Specify Other Animal Type
STRAY?
YES
NO
FERAL?
YES
NO
COMMUNITY?
YES
NO
Pet’s Name(s)
*
Age(s)
*
Sex
*
Male
Female
If known, list all breeds that apply.
*
Up to date on vaccines w/proof?
*
Yes
No
FIXED?
*
Yes
No
Microchipped?
*
Yes
No
Are vet records available?
*
Yes
No
Is this a bonded pair?
Yes
No
Any known medical conditions ?
Any known behavior conditions ?
Does your pet get along with (check any that apply):
Dogs, Large
Dogs, Small
Cats
Kids
Adults
Why are you re-homing your pet?
*
Have you tried to re-home your pet via Facebook, Craigslist, Flyers, Friends, Family, Co-Workers?
*
Yes
No
Owner Name:
*
Phone:
*
City:
*
Email :
*
Questionnaire Sent?
*
Yes
No
If not a Sedona Resident, have you reached out to your local shelter?
*
Yes
No
Owner Surrender Fee:
$75 per full grown Pet$20 per Kitten or Puppy
Confirm Owner Surrender Fee:
*
Yes
No
Owner's Initials
*
Notes or Additional Information
Date
MM slash DD slash YYYY
Consent
*
I agree to the Humane Society of Sedona Pet Surrender policies.
